Jerry Sternin’s job was to help save starving children in Vietnam. Faced with an impossible time frame, he adopted a radical approach to making change. His idea: Real change begins from the inside.

By David Dorseylong Read

If there is one profession that owes its existence to the new economy, it is the change artist. Change artists can assume various forms: They are the men and women from world-class consulting firms who drop in to companies with their patented change programs. They are the business-school professors who pen prescriptive books about the latest change offering.

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And sometimes, they are the motivational speakers who stand up in front of corporate audiences and make passionate pleas for new beginnings and self-belief.

Change artists come into town, offer their wisdom, collect their fees, and then head home, where they design more offerings, conduct more research, and pen more books. In a time of dizzying change, change programs are a growth industry. And not surprisingly, these change programs almost never work. The consultants decamp, and the company reverts to form. The book gets read, maybe even passed around, and the company reverts to form. The motivational speaker leaves to applause, and the company reverts to form.

Maybe, says Jerry Sternin, the problem isn’t with the outside experts or with the company. “The traditional model for social and organizational change doesn’t work,” says Sternin, 62. “It never has. You can’t bring permanent solutions in from outside.” Maybe the problem is with the whole model for how change can actually happen. Maybe the problem is that you can’t import change from the outside in. Instead, you have to find small, successful but “deviant” practices that are already working in the organization and amplify them. Maybe, just maybe, the answer is already alive in the organization — and change comes when you find it.

At least that’s what Sternin thinks. And he should know — not because he’s charged corporations millions of dollars to lead them through change efforts but because he has helped save thousands of children’s lives by embracing an approach to change that intentionally, forcefully, dramatically, and successfully flies in the face of conventional wisdom.

Sternin’s approach traces back to work done by Marian Zeitlin at Tufts University in the late 1980s. At the time, Zeitlin was doing research in hospitals in developing communities to find out why a small handful of malnourished children — the “deviants” — were doing much better than the majority. What enabled some children to rehabilitate more quickly than others?

From this research came the idea of “amplifying positive deviance” — a theory that Sternin and his wife, Monique, put to the test in the 1990s in a dramatically different setting: Vietnam. As staff members of Save the Children, the Sternins helped create a Vietnamese branch of the organization in response to a request by the Vietnamese government to help fight the problem of malnutrition in the country’s villages. But once there, the reception accorded the Sternins and Save the Children by the Vietnamese government was less than cordial: They had six months to produce results — and then it was time to head home.

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Faced with a difficult task and an impossible time frame, Sternin reached for an unconventional solution: amplifying positive deviance. “We call conventional wisdom about malnutrition ‘true but useless,’ or ‘TBU,’ ” says Sternin, sitting high above White Pond, not far from Walden Pond, near Boston. Sternin is on one of his brief stays at his home in the United States before he returns to his work with Save the Children in Myanmar. “It’s all about poor sanitation, ignorance, food-distribution patterns, poverty, and a lack of access to good water. Millions of kids can’t wait for those issues to be addressed. While you are there, things improve, but as soon as you leave, things revert back to the baseline. Nothing has changed. The solutions are yours. The resources are yours. When you leave, everything else leaves with you.”

When Sternin and his wife first arrived in Vietnam, nearly half of the country’s children were malnourished. The TBU model simply wouldn’t work — not in the six months that they had to make a difference. Half in desperation, half in inspiration, Sternin turned to the theory of amplifying positive deviance: In every community, organization, or social group, there are individuals whose exceptional behaviors or practices enable them to get better results than their neighbors with the exact same resources. Without realizing it, these “positive deviants” have discovered the path to success for the entire group — that is, if their secrets can be analyzed, isolated, and then shared with the rest of the group.

In Vietnam, Sternin proved that the theory worked. Now he’s spreading the word around the world. The groundbreaking work that he did in Vietnam has served as a model for rehabilitating tens of thousands of children in 20 countries.

Sternin himself is proving to be a positive deviant. A few consultants, and the companies that they serve, are starting to listen. The change model is being tested at Hewlett-Packard and at a number of other companies. The process isn’t complicated or esoteric. When people discover how it works, Sternin says, the truth seems self-evident. “It’s so exquisitely simple,” he says. “Once you hear it, there’s this automatic recognition: ‘Oh yeah, of course.’ “

Step one: Don’t presume that you have the answer.

“We were like orphans at the airport when we arrived in Vietnam,” Sternin says. “We had no idea what we were going to do. We had no delusions of grandeur. Our attitude was, Oh my God, what’s going to happen?”

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When Sternin and his wife arrived in Hanoi, they started with a clean slate, a beginner’s mind. They were ready to listen, not to talk. They knew little about Vietnam, but they were certain that the only way to come up with a plan to fight malnutrition was to discover it within the Vietnamese village culture itself.

The Sternins, along with the Vietnamese Save the Children staff and a Vietnamese volunteer named Nguyen Thanh Hien, helped mothers identify the positive deviants within their villages — the mothers whose children were not malnourished, the mothers who had discovered ways to feed and care for their children effectively. They then enabled everyone else in the village to practice those survival behaviors on their own.

Step two: Don’t think of it as a dinner party.

Lots of change programs emphasize the importance of cross-departmental teams. Sternin’s approach takes the opposite tack: When defining the community that you want to change, you shouldn’t mix people from different social groups or departments. Your aim shouldn’t be to produce a lively conversation among diverse individuals, and you shouldn’t mix and match people to jump-start the flow of creative ideas. Everyone in the group that you want to help change must identify with the others in the group. Everyone must face the same challenges and rely on the same set of resources to come up with answers. If group members don’t see themselves as working on identical challenges with identical sets of resources, then positive deviance won’t work.

“You can’t find someone whose uncle in the next village gives the family free medicine,” Sternin says. “That solution won’t work for everyone, because not everyone has such a resource. A solution has to be repeatable. It’s the same thing in business. If you try to change behavior in order to enhance sales, productivity, or communication, positive deviance can work. However, when you define the community, you have to be careful to use a definition that’s acceptable to the group. If the group feels that you’re going outside to where things are so culturally different, then it’s just another way to impose best practices, and you’re not using positive deviance.”

Step three: Let them do it themselves.

Set up a situation in which people — including those who need to change the way that they operate — can discover, on their own, a better way to do things. Raise questions, but let the group come up with the answers on its own. Establish research guidelines that isolate and analyze the behavior of positive deviants inside the group itself — and that highlight the superior results that the study achieves.

“We said, ‘Let’s test this theory out,’ ” says Sternin. “We went into four villages. We trained women to chart growth by age and weight. They compiled a list, and then we asked them if they knew of any children under age three who came from poor families but were well nourished. The answer came back: ‘Có (pronounced ‘Gah’), có, có,’ ” says Sternin, using the Vietnamese word for yes. “Then we asked, ‘You mean it’s possible today in this village for a very poor family to have a well-nourished child?’ Again, we got the same answer: ‘Có, có, có.’ “

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The Vietnamese women were amazed by the discovery. Their reaction: Let’s go see what they are doing — today, before anything changes. “That’s how it starts,” says Sternin.

Step four: Identify conventional wisdom.

Before you can recognize how the positive deviants stray from conventional wisdom, you first have to understand clearly what the accepted behavior is. Establish what it is that most group members do. Clarify the conventional wisdom of the average and of the majority.

In the case of the Vietnamese children, Sternin asked his village volunteers to observe how all mothers fed their children. The conventional Vietnamese wisdom was that certain foods were low-class, common food, even though these foods were nutritious. In general, mothers didn’t actively encourage eating. Some believed that it was not good practice to feed children with diarrhea — another tenet of conventional wisdom that led to worsening conditions.

“Conventional wisdom said no to eating certain kinds of nutritious foods,” says Sternin. “Most people were too busy working to take an active role in feeding their children. They just left food around, and if it fell on the floor, the children might eat it. Or they fed their children once or twice a day. In contrast, the positive deviants fed their children small portions many times a day, because there’s only so much rice that a starving child’s stomach can hold.”

Step five: Identify and analyze the deviants.

As you track how all people in the group go about their tasks, and as you begin to list the behaviors that they all have in common, the positive deviants will naturally emerge. At the same time, it will become clear that the deviants have found a better way; their results will prove it. If you’ve defined your community effectively (in such a way that everyone has the exact same set of resources), then the people who need to change can see how to do it — if you help them identify the positive deviants. Just as important, they won’t feel that an outside solution has been imposed on them. They will have discovered a new way of doing things themselves, making it their discovery, not yours. Analyze and list the set of behaviors that the deviants have in common. Single out exactly what makes them successful.

Certain practices became apparent among the positive deviants. These mothers used alternative sources of food, and their children thrived. In addition, they broke from conventional wisdom in a number of other areas: feeding children even while the children had diarrhea; feeding children more frequently; and making sure that the children actually ate, rather than hoping that the children would take it upon themselves to eat.

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“The positive deviants were going to rice paddies and collecting tiny shrimps and crabs to mix with the rice,” says Sternin. “They also collected sweet-potato greens — which conventional wisdom considered low-class food — and mixed them with the rice. They were supplementing the carbohydrates with protein and vitamins. And positive deviants displayed all kinds of caring behaviors: frequency of feeding, active feeding. They fed children who had diarrhea, for example, even though conventional wisdom said no to this.”

Step six: Let the deviants adopt deviations on their own.

“The next step is critical,” Sternin says. “Once you find deviant behaviors, don’t tell people about them. It’s not a transfer of knowledge. It’s not about importing best practices from somewhere else. It’s about changing behavior. You design an intervention that requires and enables people to access and to act on these new premises. You enable people to practice a new behavior, not to sit in a class learning about it.”

Sternin makes a point of emphasizing the distinction: Don’t teach new knowledge — encourage new behavior. Let the people who have discovered the deviations spread the word in their group. Don’t require adherence to the new practices, but do offer incentives for it.

In Vietnam, for example, a health volunteer would invite 8 to 10 mothers into her home for medicinal-food training. As a price of entry, the mothers were required to bring a contribution of shrimp, crabs, and sweet-potato greens. The volunteers and the mothers would then use those ingredients, along with rice, to cook a meal for the entire group. After two weeks of this, the session was over. Most of the group would continue to gather shrimp and greens, and their children would continue to recover. Those mothers whose children didn’t rehabilitate could re-enroll and go through the two-week process again, over and over, until their children were rehabilitated and the behavior became habitual.

Step seven: Track results and publicize them.

Save the Children’s next step: Post the results, show how they were achieved, and let other groups develop their own curiosity about them. Celebrate success when you achieve it. Go back on a periodic basis and observe how different groups have changed, and track the results quantitatively to show how positive deviance works. Chip away at conventional wisdom, and gradually alter low expectations by showing, in indisputable terms, the results that come with doing things differently.

“It was wildly successful,” Sternin says. “We saw malnutrition drop 65% to 85% throughout the villages in a two-year period. But that’s not all that’s thrilling: The Harvard School of Public Health came to the four original villages and did an independent study. They found that children who hadn’t even been born when we left the villages were at the exact same enhanced nutritional levels as the ones who benefited from the program when we were there. That means that the behavior sticks.”

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Step eight: Repeat steps one through seven.

Make the whole process cyclical. Once people discover effective ways to deviate from the norm, and once those methods have become common practice, it’s time to do another study to find out how the best performers in the group are operating now. Chances are that they’ve discovered new deviations from the new norm. The bell curve of performance keeps moving up, as long as you disseminate the best deviations across the curve and continue to discover new examples of positive deviance among the next group of best performers.

Sternin took his positive-deviance program to a total of 14 Vietnamese villages after succeeding in the initial 4. As the program grew, it uncovered new solutions in new localities — sesame seeds, peanuts, snails. The answers were never quite the same. Different solutions grew out of different soils. But the process remained the same: Discover original local answers to the problem, and then give everyone access to the secrets.

“Save the Children came up with the idea of a living university,” says Sternin. “We took the first 14 villages in different phases of the program and turned them into a social laboratory. People who wanted to replicate the nutrition model came from different parts of Vietnam. Every day, they would go to this living university, to these villages, touching, smelling, sniffing, watching, listening. They would “graduate,” go to their villages, and implement the process until they got it right. Then they would use their village as their own mini living university to expand the program locally. In effect, the entire village itself would become the positive deviant for the neighboring villages. The program reached 2.2 million Vietnamese people in 265 villages. Our living university has become a national model for teaching villagers to reduce drastically malnutrition in Vietnam.”

Over the past decade, positive deviance has been applied to the problem of malnutrition in more than 20 countries through Save the Children. Other non-governmental organizations have applied it in many countries as well, including Bangladesh, Bhutan, Bolivia, Cambodia, Egypt, Ethiopia, Haiti, Myanmar, Nepal, and Sri Lanka.

News of Sternin’s work in Vietnam spread rapidly among a variety of non-governmental organizations. Positive deviance is now being applied around the world to change behavior in a variety of other social and organizational situations, such as the spread of AIDs in the Third World and ethnic conflicts in Africa.

Although he has not worked as a consultant within a business setting himself, Sternin says that the HR department at Hewlett-Packard has shown interest in using positive deviance to identify ways to improve quality of work and worker satisfaction. And the European offices of management-consulting group Rath & Strong have applied the practice within many manufacturing companies.

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“A very successful pharmaceutical company had one unit that far outsold all of the other groups,” Sternin says. “They believed at the time that the more sales reps you had and the more calls you made on customers, the more you would sell. The positive deviants within the company, the most successful units, had fewer salespeople, and they made fewer calls. They made one-third the number of customer visits per day. They found that these reps were spending far more time with individual doctors, educating them on the benefits and the uses of the products that they sold, talking about research. And they were outselling the others by a big margin.”

But the effect of the positive-deviant model for change can’t be measured entirely by the numbers, or by the obvious results. The people Sternin has helped throughout the world have invariably felt that he not only solved problems by showing them how to change but also altered their lives in fundamental ways too deep to measure. The message that Sternin carries with him as he continues his work as his own form of a positive deviant comes from a Bangladeshi village woman. “Let us tell you about the changes in our lives,” the villager told Sternin and his wife. “We were like seeds locked up in a dark place, and now we have found the light.”

David Dorsey (dedorsey@rochester.rr.com) is a best-selling business author and a novelist. contact Jerry Sternin by email (jsternin@scusmyanmar.org), or visit Save the Children on the Web (www.savethechildren.com).

A version of this article appeared in the December 2000 issue of Fast Company magazine.